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From Flashcardlet > CVA, Brain tumors, Inflammatory Diseases, etc. > Flashcards

CVA, Brain tumors, Inflammatory Diseases, etc. Flashcards

1
Q

What happens when there is a sudden impairment of cerebral circulation?

A

Cerebral Vascular Accident a.k.a. CVA, Stroke, & “Brain Attack”

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2
Q

What is the 3rd leading cause of death?

A

CVA

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3
Q

What is the most common neuro disability?

A

CVA

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4
Q

Who do CVAs affect?

A

all ages but mostly elderly

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5
Q

What happens when the vasospasm from microemboli temporarily decrease blood flow through cerebral artery?

A

Transient Ischemic Attack a.k.a. ~ TIA or “Mini stroke”

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6
Q

What is the difference between a TIA and CVA?

A

With the TIA once vasospasm stops or the embolus dissolved (through normal lysis) symptoms resolve.

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7
Q

What can conditions can increase your risk for a CVA?

A 
History of TIA
Atherosclerosis
HTN
Arrhythmia
DM
Rheumatic heart disease
Cardiac enlargement
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8
Q

What lifestyle problems can increase risk for CVA?

A 
Increase Triglycerides.
Sedentary lifestyle
Smoking
Oral contraceptives
Family Hx.
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9
Q

What are the 3 types of CVAs?

A

Thrombotic, Embolic, Hemorrhagic

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10
Q

What is the most common type of CVA?

A

thrombotic

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11
Q

Which CVA type is located in the middle cerebral artery?

A

embolic

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12
Q

What do patients that have a CVA embolism normally have a history of?

A

rheumatic heart disease, MI, or arrhythmias such as atrial fibrillation.

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13
Q

What percentage of blood supply to the brain is the middle cerebral artery responsible for?

A

80%

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14
Q

What can a intracerebral hemorrhage lead to?

A

death of the brain cells

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15
Q

What happens to the brain tissue when there is a subarachnoid hemorrhage?

A

displaces brain tissue and can result in compression of vessels, leading to death of cells as well.

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16
Q

What med is given for embolic/thrombolic?

A

Clot busters

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17
Q

Who can receive clot busters?

A

anyone who has no recent history of head injury (including head bumping) exist

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18
Q

Why do you not give a clot buster to anyone with a head injury?

A

can cause hemorrhage and worsen condition

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19
Q

What treatment is done for embolic/thrombolic?

A

ASA
Anticoagulants
Carotid endarterectomy

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20
Q

Which med will decrease platelet aggregation for thrombotic type CVA’s or TIA’s?

A

ASA

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21
Q

What may low dose ASA cause?

A

some mild vasodilation and therefore is helpful with TIA’s

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22
Q

When are anticoagulants given?

A

Only if it is known that CVA is from embolus or thrombosis

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23
Q

Are anticoagulants given if it is hemorrhagic?

A

no

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24
Q

If hemorrhagic, what will they be started on?

A

IV heparin

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25
Q

What is it when plaque is removed from narrowed carotid arteries, to reestablish blood flow to the brain?

A

Carotid endarterectomy

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26
Q

How is hemorrhagic treated?

A

HOPE! You just have to wait until the bleed stops and maintain the pts. ABCs until it does.

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27
Q

Can the damage from a hemorrhagic CVA be reversed?

A

no

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28
Q

What should the pts. O2 be at for CVA?

A

hyperventilate to get more O2 to the damaged tissues

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29
Q

What are nursing considerations for CVA?

A 
ABC’s 
Adequate nutrition – watch neglect
Preserve function
Rehabilitation
Protect from injury
Education
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30
Q

What injury needs to be prevented with CVA?

A

foot drop

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31
Q

How long will rehab take for CVA?

A

Neuro injury recovers over years

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32
Q

Will people with CVA exhibit signs of quadriplegia or paraplegia?

A

not unless there is some underlying spinal cord disruption

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33
Q

Will people with CVA show signs of hemiplegia?

A

yes, sometimes

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34
Q

since one side of someone with a CVA doesnt function as well as the other, what should be considered with the patients care?

A

Make sure to put everything on the functioning side, such as their call light and where the bathroom is so care is easier for them.

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35
Q

What is the incidence of primary and metastatic brain tumors?

A

17,500

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36
Q

What is the most common brain tumor

A

gliomas (45%)

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37
Q

What are the other types of brain tumors?

A

15% meningiomas 7% acoustic 7% pituitary 18% metastatic

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38
Q

What are s/s of brain tumor?

A 
HA
N&V
Increased ICP
Visual changes
Seizure
Weakness
Hemiparesis
Speech changes
Personality changes
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39
Q

If someone has personality changes, inappropriate affect, motor dysfunction, aphasia, seizure, where is the brain injury?

A

frontal lobe

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40
Q

If someone has HA, seizure, visual changes, where is the brain injury?

A

occipital

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41
Q

If someone has olfactory, vision, complex partial seizure, receptive aphasia where is the brain injury?

A

temporal lobe

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42
Q

If someone has inability to replicate pictures, less R-L discrimination, seizures, parasthesias, sensory, where is the brain injury?

A

parietal lobe

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43
Q

What is the medical management of brain tumors?

A 
Chemotherapy
Steroids
Anti-seizure meds
Surgery
Radiation
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44
Q

What is a brain abscess or swelling?

A

encephalitis

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45
Q

When does encephalitis commonly happen after?

A

skull fracture

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46
Q

What is inflammation/infection of the meninges?

A

meningitis

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47
Q

When is there a good prognosis of meningitis?

A

if caught early

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48
Q

if meningitis isn’t treated, what is the mortality rate?

A

70-100%

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49
Q

Who is there a higher mortality in with meningitis?

A

children

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50
Q

Do adults or children recover better from a CVA?

A

children because some of their damage can be reversed since their brain is still developing. With adults its irreversible.

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51
Q

what can cause meningitis?

A

Bacteria, viruses, protozoa, fungi or 2nd to other infections

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52
Q

What infections of other conditions can cause meningitis?

A 
Pneumonia
Sinusitis
Osteomyelitis
Empyema
Otitis media
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53
Q

What are symptoms of viral meningitis?

A

HA, fever, vomiting, meningeal symptoms

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54
Q

What viruses can cause viral meningitis?

A

Enteroviruses, aboriviruses, herpes simplex, mumps

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55
Q

Is viral meningitis a sudden onset or slower?

A

sudden

56
Q

What are clinical manifestations of viral meningitis?

A

HA, temp, change LOC, stiff neck, recent illness, NV, abd pain,

57
Q

What would bacterial cultures come back as for viral meningitis?

A

negative

58
Q

What needs to be increased in CSF with viral meningitis?

A

protein

59
Q

Around what would someones temp go up to with viral meningitis?

A

101/102 F

60
Q

How do you treat viral meningitis?

A 
BR
Fluid and electrolyte balance
Analgesics for pain
Exercise
Careful hand-washing
61
Q

Does there need to be isolation for viral meningitis?

A

NO

62
Q

What bacteria can cause bacterial meningitis?

A

Haemophilis meningitis
Pneumococcal meningitis
Meningiococcal meningitis

63
Q

Do you isolate someone with bacterial meningitis?

A

YES!!!!

64
Q

How do you diagnose bacterial meningitis?

A

LP - culture CSF

+ Kernig and Brudzinski

65
Q

What meds are given for bacterial meningitis?

A

IV or intra-thecal antibiotics
Steroids
Anticonvulsants
Antipyretics

66
Q

When is resp isolation done for bacterial meningitis?

A

if it is meningococcal

67
Q

Why do ice packs and cooling blankets need to be put around a pt with bacterial meningitis?

A

because their temp could get up to 106 F or above

68
Q

What sign is performed when you lift the patients head up and the knees go up too when checking for meningitis??

A

Brudzinskis

69
Q

What sign is performed when you lift the patient’s leg and their knee bends to check for meningitis?

A

Kernig’s

70
Q

What disease produces sporadic but progressive weakness and easy fatigue of skeletal muscle?

A

Myasthenia Gravis

71
Q

What muscles are usually affected with MG?

A

Usually muscles of CN’s or other muscle groups

72
Q

When is MG life-threatening?

A

Life threatening if affects respiratory muscles

73
Q

What is MG caused by?

A

autoimmune disorder

74
Q

What happens when antibodies are produced by the thymus and block neuroreceptor by attaching to acetylcholine receptor sites thus not allowing the neurotransmission?

A

Myasthenia Gravis

75
Q

What are primary complications of MG?

A

Respirator distress

Chewing or swallowing difficulties

76
Q

What are the main clinical manifestations of MG?

A 
Progressive muscle weakness
Ptosis and diplopia
Chewing/swallowing difficulties
Rare report of leg weakness
Sleepy expression
Drooping jaw
Hypoventilation
77
Q

What is normally the first sign of MG?

A

eye muscle weakness

78
Q

When is MG milder and when should care be done?

A

in the AM

79
Q

What diagnostic test is performed for MG?

A

Tensilon test

80
Q

What test is performed when temporary improvement in symptoms after IV injection of edrophonium or neostigmine?

A

Tensilon test

81
Q

When are positive results for Tensilon test seen?

A

within 3-60 sec

82
Q

What does tensilon test differentiate between?

A

myasthenia crisis and cholinergic crisis

83
Q

If the tensilon test is positive, what does the pt have?

A

myasthenia crisis

84
Q

When does MG get worse?

A

With each flare up, and they dont go back to how they were before the flare up

85
Q

What is a primary cause of a flare up for MG?

A

stress

86
Q

What meds are given for MG?

A

Anti-cholinesterase (neostigmine)

Steroids

87
Q

What procedures can help MG?

A

Plasmaphoresis

Thymectomy

88
Q

What may a person with MG have to have to help with O2?

A

Trach

Ventilator

89
Q

Will other anti-cholinesterase drugs help MG?

A

no

90
Q

What are nursing interventions for MG?

A

relieve symptoms and acute exacerbations
Psych support
Establish neuro/resp baseline

91
Q

Why is psych support important with MG?

A

it is a life-long condition

92
Q

What do nurses need to be alert for with MG?

A

s/s of crisis

93
Q

when should meds be given with MG?

A

Give meds on time

Admin meds 20-30 min before eating

94
Q

What foods should be given to a pt with MG who has swallowing problem?

A

soft semi-solid

95
Q

What should a pt with MG be taught?

A

avoid strenuous activity and alcohol

96
Q

What is polyneuritis that causes segmentation of peripheral nerves?

A

Guillain-Barre Syndrome

97
Q

What phase of GBS has an onset-1-3 weeks when no further deterioration?

A

Acute

98
Q

What phase of GBS last several days - 2 weeks?

A

Plateau

99
Q

What phase of GBS coincides w/ remyelinization and axonal process regrowth (4-6 months)?

A

Recovery

100
Q

In 80% of patients with GBS, when do s/s happen?

A

symptoms began about 5 days to 3 weeks after a mild infection, surgery, or an immunization

101
Q

What is believed to be cell mediated immunologic attack on peripheral nerves in response to a virus (Epstein Barr), therefore cannot transmit messages to the brain correctly?

A

Guillain-Barre syndrome

102
Q

What is the cause of GBS?

A

unknown

103
Q

What happens to the myelin sheath with GBS?

A

degenerates–>inflammation-> swelling and demyelinization.

104
Q

When is there sensory deficits with GBS?

A

if dorsal root involved

105
Q

When is there motor deficits with GBS?

A

if ventral root involved

106
Q

Where does paralysis start with GBS?

A

at the feet then goes up the body

107
Q

How many days do you have to get a trach in with someone who has GBS?

A

14 day window

108
Q

What are complications with GBS?

A 
Thrombophlebitis
Pressure ulcers
Contractures, muscle wasting
Aspiration, respiratory infections
Cardiac compromise
109
Q

What age is GBS common in?

A

20-50 year old

110
Q

How fast does GBS progress?

A

rapidly over 2-3 wks

111
Q

how much muscle atrophy is there with GBS?

A

minimal

112
Q

What history should be assessed for when determining GBS?

A

Hx of febrile illness (up to 4 weeks prior)

113
Q

What other manifestations should be assessed for in someone with GBS?

A

Stiffness in calves
Neuro weakness
Sensory loss
Cranial nerve deficits (diff speech, chewing, swallowing, ocular, facial nerve paralysis

114
Q

What diagnostic test are done for GBS?

A

Increase protein in CSF
EMG
Electrophysiologic studies

115
Q

What will electrophysiologic studies show with GBS?

A

slowing of nerve conduction velocities

116
Q

What is treatment of GBS?

A

Supportive
Intubation/trach
ECG monitoring
Plasmaphoresis

117
Q

What needs to monitored with GBS?

A 
VS, LOC
Resp status, breath sounds, vent support
Skin care
 Assess gag
Check for urinary retention
118
Q

What are interventions for GBS?

A 
Eyedrops/shield
Relieve constipation
Communication alternatives (pen and pad, etc.)
Diversion
Family support
119
Q

What is AKA “tic douloreaux”

Painful disorder of 1 or more tracts of the 5th(trigeminal nerve) CN?

A

Trigeminal Neuralgia

120
Q

What gender is most commonly affected by TN?

A

female

121
Q

What does TN normally feel like?

A

Burning sensation lasting 1-15 minutes

that may subside spontaneously

122
Q

What is TN precipitated by?

A

air, heat/cold, eating, smiling, drinking hot/cold beverages

123
Q

What may patient have to do to the area that is in pain with TN to relieve it?

A

splint it

124
Q

What meds are given for TN?

A

Carbemazepine (tegretol) or Dilantin

125
Q

What treatment for TN will cause partial numbness of face?

A

Percutaneous radiofrequency treatment

126
Q

What is the benefit of microsurgery vs craniotomy for TN?

A

advantage is no sensory loss in face

127
Q

What happens when there are blocked impulses from 7th CN 2nd to inflammatory reaction around the nerve
causing unilateral facial weakness/paralysis?

A

Bell’s Palsy

128
Q

What age is Bell’s Palsy common in?

A

20-60 y/o

129
Q

How many with BP have a spontaneous resolution?

A

80-90%

130
Q

Can BP recur?

A

yes

131
Q

What is the cause of BP?

A

Unknown cause but could be viral autoimmune or traumatic injury

132
Q

What are eye complications with BP?

A

Corneal ulceration and blindness

133
Q

What are two other complications of BP?

A

Decreased nutrition

Psychosocial problems

134
Q

What needs to be assessed for with BP?

A

Drooping mouth, difficulty eating, taste perception disorder, cannot puff cheeks, raise eyebrows, or show teeth.

135
Q

What drugs are given for BP?

A

prednisone and analgesics

136
Q

What are the nursing interventions for BP?

A

Mainly supportive
Assist with nutrition
Prevent corneal abrasions
Emotional support

From Flashcardlet (107 decks)

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